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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Experience:  Dr. Mark is a PhD in psychology in private practice
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Hi! I have a daughter aged nine that has been troubling me

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Hi! I have a daughter aged nine that has been troubling me since age of two. It all started off when I left her at that time and went away on pilgrimage for six weeks. When I returned, she was fine for two days, then the tantrums started. She would get nothing under four to five tantrums in a day including late at night when everyone is asleep. She would get up screaming and all she would say is, "Carry me." Nothing would calm her down and she would scream and cry not even knowing what she wants with her eyes closed. We took her to every kind of doctor, occupational therapist etc, etc and all that they picked up was separation anxiety. There was no improvement in her behaviour. Then when she started school, it was very difficult to get her to school. The first year in Grade R, I had to give up half way through the year because she was driving me nuts. Every morning was a cry and a tantrum before school. Somehow through all this she started going to school, tantrum and everything, but this time I had to stay firm. She was brilliant in class, but the minute she came home, she would start to annoy me and cry for every little thing. The tantrums somehow settled. Then at age 7, she had an accident. The driveway gate fell on her head and was rushed to hospital. She is fine, but has definite scarring in her hairline and her forehead. She only troubles me all the time. She loves my parents and whenever goes for the weekend, she is totally different. Never demands anything, very calm, no screams, no frustration. She takes forever to get her homework done, does not like to listen to me, is always frustrated, never eats whatever food there is, always picks on her eldest and younger brother............................She cries for every little thing and thereafter she says that she is sorry and it won't happen again. I am desperately in need of HELP or I might end up losing my SANITY.

Hi! I'll be glad to be of help with this issue.

I can imagine how frustrating this situation must be for you. You are clearly a loving and caring mom and your daughter is indeed acting in very, very extreme ways. It's amazing that you're still this patient after this much time.

What is so extraordinary here is that separation anxiety really does seem like the only diagnosis available. But it is obviously more than that. However, there does not seem to be any developmental aspect to this: she can easily change and control her behavior at will, like at school and grandparents' house. That's not usual with developmental issues. So we have an attachment disorder here. And that's very unusual with you having left for only 6 weeks at age 2. I don't know what may have happened while you were away, though if anything dramatic occurred, I'm sure you would have been informed. So it was the separation from you that long ago that is driving this. Remarkable.

But that leaves you with this awful situation. Given that it's not a standard attachment disorder issue, I urge you to treat the problem with behavioral therapy. I think you need to do this both with a therapist and at home. This is now so entrenched in her that she most likely has no clue why she behaves the way she does when she's with you and at home.

The principles of Behavioral Therapy are rather straightforward: you reward the behavior you want to have her do and you don't reward the behavior you want her to avoid. Punishing bad behavior will most likely not succeed, it seems. She's way too entrenched after all this time in her fears and behavior patterns. She will most likely just take the punishments and keep on doing the same behaviors. I imagine this is what you've been experiencing.

Therefore, rewarding the desired behavior is the part of BT you want to work with her in. It is indeed easy and so can be deceiving. That's why I'd urge you to work with an experienced child psychologist or psychotherapist whose focus is in Behavioral Therapy. You need to make the rewards varied and appropriate to the behavior you are encouraging and you need to have the guidance on how to institute behavioral change techniques.

If her doctor doesn't have a good referral, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (they show you a photo of the therapist!) look at the listing and see if they are experienced with children and work in BT or CBT.


http://therapists.psychologytoday.com/rms/

 

Okay, I wish you the very best!

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Customer: replied 3 years ago.
Thank you so much for your response. I have been reading about Oppositional Defiant Disorder. Do you think that she may be suffering from this? Is there a chance that she will ever settle? I have tried behaviour therapy at home, It helped at first, but she started manipulating me after some time. I had a point system, so that after a certain amount of points, she gets rewarded. I have 4 other children, 2 old enough to understand ie 17 years and 15 years, but the two after her are 7 years and 5 years respectively. Her behaviour is making an impact on them and they are also trying to get their way with me. So every time it was why I always give her Negative points...Please advice
Your daughter is way too young to be diagnosed with ODD as a primary diagnosis. At her age, ODD is a diagnosis used when there is no real diagnosis identified. It describes behavior. Her behavior, though, doesn't fit ODD. It is too specific to you and the family dynamics, not to general behavior. In other words, it is relationship based and that's why it was identified as separation anxiety originally.


It's possible that your daughter will "graduate" to ODD. But let's hope not. I know that you are desperate to have some sort of explanation to give the frustrating hellishness of it all some sense. But if your daughter gets labeled with ODD, it will follow her throughout school and adolescence and can become a self fulfilling prophecy where she will begin to act with everyone like she's acting with you. At least now, she's expressing some primal feelings that have to do with a long ago separation she never got over. That's much better than ODD, though I know it doesn't seem like that for you.


Your effort with rewards is way too intellectualized for her. That's why I urge you to do this with a therapist advising you who has gotten to know her. Remember, whatever the internal forces driving this behavior, she is not consciously doing this. My experience tells me this is almost certain. She is more frustrated than you are. She doesn't know HOW to change her behavior because it is not consciously being done.


So, the behavior modification techniques have to be much more impulse control oriented. That means immediate reinforcement for positive behavior. Behavioral Therapy is not just about rewards. It is about reinforcing the desirable behavior. Rewards can help. But all reinforcements are necessary: praise, soothing, etc.


Please don't give up on her. Work with a therapist who you think is smart and kind. And as for the other kids, have a family meeting with them without her. Discuss the problem without getting too much into details, just briefly about her having a long term problem from when she was 2 because of trauma of you leaving. Explain that it isn't that she gets away with things. It's that she has a problem. And that you need them to be part of the family, helping her by not acting as if she's getting away with something. And helping you by not taking advantage.


Stress that you're a family and that this isn't your problem with her. That as a family everyone needs to understand that she has a problem and that you are all on her side, praying for her (if your family prays) and being helpful to let her see how things should be. And let them know how much you love them and that you know that she takes up a lot of your energy but that they shouldn't think that they aren't as important to you, etc. The younger kids: make it simple for them. Address the older kids more. And you might ask the therapist if there could be some family sessions to help as well.


You see, my approach is that your daughter has a problem that we don't want to spread into her being labeled as a problem kid. And so the whole family may have to pitch in as well.


I wish you the very best!


My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX
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